BEUDAMED
    FDA Adverse Event Death Summary report: N

    PIN MULTIHOLE II ACE CUP 62MM

    MDR report key: 541510 · Received August 31, 2004

    Report

    Report Number
    1818910-2004-00592
    Event Type
    Death
    Date Received
    August 31, 2004
    Date of Event
    July 15, 2003
    Report Date
    August 10, 2004
    Manufacturer
    DEPUY ORTHOPAEDICS, INC.
    Product Code
    LPH
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UT, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    CLINICAL REPORT STATES PT'S PRIMARY DIAGNOSIS WAS REVISION IMPLANT LOOSENING, TYPE COMPLICATION STATES POST OPERATIVE AND COMPLICATION STATES DEATH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PIN MULTIHOLE II ACE CUP 62MM TOTAL HIP REPLACEMENT LPH DEPUY ORTHOPAEDICS, INC. NA WP8GK1009

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Death| R